Monthly Archives: February 2015
Older people and eating disorders: not ‘just a teenager’s problem’

Eating disorders are often portrayed as a disease that only affects the young and privileged, yet this is not the case. Eating disorders can affect anyone at any time, regardless of age, gender identity, race, ethnicity, sexuality or cultural background.

While eating disorders are often considered to be a “teenager’s problem,” older people can also be affected by these diseases.

Not only are they susceptible to eating disorders, but there are a number of unique problems that are experienced by this social group.

“We have heard of cases where physicians have told patients that they should have ‘grown out of’ eating disorders,” Prof. Cynthia M. Bulik told Medical News Today. “Or that they are ‘too old’ to immigration-consultant-lawyer-canadian-australian-newzealand-student-visas-karachi-lahore-islamabad-peshawar-faisalabad-pakistan-be suffering fromanorexia, bulimia or binge-eating disorder.”

In this Spotlight feature, we investigate precisely how older people can be affected by eating disorders, what unique problems they face and what is currently being done to raise awareness of this issue.

What are eating disorders?

Eating disorders are serious conditions that can have a significant impact on an individual’s physical and emotional health, as well as affecting their productivity and their relationships.

These diseases have the potential to be life-threatening, and anyone that develops an eating disorder should seek professional help. The National Institute of Mental Health (NIMH) state that people with anorexia nervosa are 18 times more likely to die early, compared with people of similar ages in the general population.

According to the National Eating Disorders Association (NEDA), around 20 million women and 10 million men in the US experience a clinically significant eating disorder at some point in their lives.

Common forms of eating disorder include:

  • Anorexia nervosa: a disorder characterized by a distorted perception of body weight and a significant fear of gaining weight. People with anorexia nervosa often go to extreme measures to lose weight or prevent weight gain
  • Bulimia nervosa: a disorder characterized by people eating a lot of food (bingeing) and then attempting to get rid of the extra calories in unhealthy ways. This can take the form of “purging,” through self-induced vomiting or the misuse of laxatives, for example
  • Binge-eating disorder: a condition whereby unusually large amounts of food are frequently consumed, accompanied by a compulsion to do so.

Each of these conditions is associated with food and weight to varying degrees. However, such is the complexity of these disorders that they usually arise from a combination of factors – biological, interpersonal, psychological and social.

These factors can be directly related to food and weight, such as cultural pressures that place great value on obtaining “the perfect body,” and feelings of low self-esteem that may or may not tie into these. Equally, eating disorders can be associated with seemingly unrelated factors such as depression, anxiety, loneliness, introversion and a history of abuse.

Food can be seen as a way in which painful emotions and experiences that might otherwise feel overwhelming can be controlled and dealt with – a coping mechanism. Despite potentially providing a feeling of control, however, eating disorders can severely damage a person’s physical and emotional health.

In terms of physical health, obesity caused by binge-eating disorder can increase the risk of diabetes, hypertension,heart disease and some forms of cancer. Likewise, anorexia can lead to anemia, kidney problems, bone loss and heart problems, such as arrhythmias or heart failure.

Why are eating disorders less recognized in older adults?

While the dangers of eating disorders are well documented, their effect on older adults is not. But why is it that this is the case? MNT asked a number of experts, and one of the overriding responses was a general misconception that eating disorders are disorders of youth.

Empty fridge.
Older people may have difficulty buying or obtaining groceries, but missing food could also be a sign of an eating disorder.

“People fail to recognize that eating disorders can strike people of any age,” said Prof. Bulik, the founding director of the University of North Carolina Center of Excellence for Eating Disorders. “They think that people magically grow out of eating disorders when they leave adolescence. Nothing could be farther from the truth.”

Although the majority of literature and research on eating disorders focuses on younger people – females in particular – and while many eating disorder cases may feature young people, there is plenty of evidence to demonstrate that these diseases are not exclusive to those under 30.

Rather than growing out of eating disorders, many people with these diseases continue to live with their condition from adolescence all the way into late adulthood.

Laurie Cooper, site director at the Renfrew Center in Nashville, TN, told MNT that an erroneous assumption that older adults are not affected by eating disorders has an adverse effect on diagnosis:

“Rather, many family members or helping professionals may attribute weight loss, malnutrition or unexplained symptoms such as vomiting or diarrhea to a ‘normal’ aging process or some other medical condition, rather than amental health disorder.”

In addition, Cooper explained that many individuals who have recovered from eating disorders can experience relapses. Due to their age and status of being in “recovery,” any signs of relapse can be interpreted differently to how they may have been interpreted when the individual was younger.

Unfortunately, some of the symptoms of eating disorders are similar to those associated with the aging process. Older adults may require medication that causes nausea, or they may have functional problems that impair their ability to obtain groceries or plan an adequate diet.

However, even when older adults are living with assistance, eating disorders can still manifest and remain undiagnosed. Prof. Bulik explained:

“We have seen cases of laxative abuse in assisted care facilities, where they often hand laxatives out like candy, but the patients clearly had eating disorders and were using laxatives to purge. We have seen cases of anorexia motivated by beliefs that caloric restriction will extend life.”

The erroneous assumption of eating disorders being exclusive to the young represents one of several unique problems that older adults have to cope with in their fight with these diseases. Help is nearly always required for treating eating disorders, and the first step toward treatment is diagnosis.

A series of unique problems

Age plays an important role in how people cope with disease, both physically and mentally, and this is precisely the case when it comes to eating disorders. As specified earlier, eating disorders can lead to various other serious health problems, and as age increases so do the risks these entail.

“One of the main concerns is that eating disorders take a tremendous toll on just about every bodily system,” explained Prof. Bulik. “In old age, these body systems are less resilient to begin with, just because of the aging process, so eating disorders can erode them more quickly and more seriously.”

Conditions that are more common among older people, such as cardiac problems, gastrointestinal problems,osteoporosis and obesity, can all be exacerbated and complicated further by the presence of an eating disorder.

The combination of older bodies becoming more vulnerable and the underdiagnosis of eating disorders can also make older adults less likely to seek help for these conditions. Even if an individual knows they have a problem, this combination could be enough to put people off seeking help.

Sad unhappy older person.
Many unique and often irreversible life changes occur among the elderly, such as the death of a spouse.

Prof. Bulik told MNT that dismissive comments from physicians – telling patients that they should have “grown out of” eating disorders or that they are “too old” for them – can be a real disincentive to pursue treatment. “Those sorts of comments just lead people to go back into the shadows and not reach out for the treatment they deserve.”

Cooper also suggested that older people could have less support and motivation provided by others to go and seek treatment. “Some individuals may have fewer future goal-related motives for recovery as they see themselves in an end-of-life phase, already anticipating poor health or death.”

Whereas young people may look forward and see a bright future to be had after overcoming an eating disorder, older people may accept these diseases as just another symptom of getting older.

A final unique and inescapable problem comes from the fact that eating disorders are often related to an individual having to cope with stressful life events and needing a way to take control back at a time when they may feel as though they have none at all.

As people age, the chances of them experiencing such an event – the death of a loved one, retirement, increasing loss of independence – increase. “Coping with these mood changing, stressful life events may leave the elderly finding that their current coping skills are not adequate for their present life circumstances,” said Cooper.

Each of these factors represents a challenge posed by eating disorders that are far less likely to be experienced by the young and otherwise healthy individuals who are traditionally associated with these serious diseases.

What is being done?

This week marks National Eating Disorders Awareness Week. One thing that is apparent is how great the need is for awareness to be raised about eating disorders – particularly among smaller sociodemographic groups who are not traditionally associated with eating disorders.

To this end, the NEDA are collaborating with the feminist activist and editor of Everyday Feminism, Melissa A. Fabello, on the Marginalized Voices Project.

“Our goal is to create a collection of stories that tells the whole truth – by spanning the entire spectrum, highlighting stories from people of marginalized identities and that challenge misconceptions – so that we can present the world with what the reality of most eating disorders look like,” the NEDA state.

Stories have been collected specifically focusing on underrepresented experiences and communities with the aim of creating a platform for people to share what it is like having and recovering from an eating disorder.

The project will be launched in the near future, and it is projects like this that are likely to have the biggest impact on the treatment of eating disorders. Raising awareness will hopefully lead to more people seeking treatment and improved rates of diagnosis.

This year’s awareness week theme is “I had no idea,” specifically addressing the need to acknowledge the diverse experiences of people who are affected by eating disorders. “Too often,” say the NEDA, “signs and symptoms are overlooked as insignificant behaviors when in fact many of these are early warning signs of eating disorders.”

Anyone can get involved with these efforts. NEDA suggest that educating yourself and others about eating disorders, debunking myths and spreading the facts are great ways to raise awareness of these diseases in older people. There are also a number of charities that focus on providing information, research and treatment for these diseases.

“The triggers may differ in late life,” said Prof. Bulik, “but the disorders can still take hold.” In order to improve the lives of thousands of people, this message needs to be heard loud and clear.

 


Nurture, not nature, could be a larger issue when dealing with the obesity epidemic

Some scientists say that when mothers eat poorly during pregnancy, they pass along traits to their children that make them more likely to have poor diets and have related health problems.

But a new study in mice by researchers in the Virginia Tech College of Agriculture and Life Sciences and the Edward Via College of Osteopathic Medicine has shown that the environment in which a child lives may be an equal if not stronger force in determining obesity than their mother’s diet.

In other words, nurture, not nature, could be a larger issue when dealing with the obesity epidemic.

The researchers found that having too many food choices increases the obesity problem. In fact, researchers found that having a choice of a high-fat and low-fat diet does not help — offspring in this situation tended to eat even more. Their findings were recently released in the journal Endocrinology.

“We like variety,” said Deborah Good, an author of the paper and an associate professor of human nutrition, foods, and exercise at Virginia Tech. “But when there is a choice, we eat more than when there is not any variety.”

Though the study was done using mice, it can help inform researchers of how human’s natural environment can affect food choices and ultimately a person’s weight. In a country where one-third of adults and 17 percent of children are obese, understanding the root causes of the problem is imperative.

It is the first study of its kind to look at the issue in terms of mimicking a real world environment in which people have the choice between eating fattening foods or healthy low-fat ones. Previous mice studies investigating the role of a mother’s diet in offspring obesity have limited the offspring’s food choice to only high-fat or low-fat diets, but anyone who has walked past the candy aisle to get to the produce section can tell you that is not an accurate representation of life in America. We are constantly faced with making choices and that’s not necessarily a good thing when it comes to obesity.

“We have found that environmental factors are just as important if not more so than a mother’s diet when it comes obesity,” said George Davis, professor in both the Department of Human Nutrition, Foods, and Exercise and the Department of Agricultural and Applied Economics at Virginia Tech.

Renee Prater, the associate dean for curriculum, assessment and medical education at the Edward Via College of Osteopathic Medicine, was also an author.

In this study, the team had two sets of mothers – those given a high-fat diet, and those given a low-fat diet. The offspring were then given a diet that was high fat, low fat, or one in which they had a choice of foods.

The offspring that had a choice of high- or low-fat foods had an increase in body weight, body fat, and glucose levels. Those on a low fat diet showed no such negative impacts. They did, however, have a higher energy expenditure compared to those on low- or high-fat diets. Essentially, the mice burned more energy as they wandered around and evaluated which food they were going to eat.

But having a choice of either a high-fat or low-fat diet can lead to overeating, the experiment found. It is not unlike if someone had the choice of healthy and fatty foods in a grocery store – they may pick both, which leads to a higher daily fat intake.

Though the study was done on mice, the researchers believe the results are telling and could apply to humans. The authors hint that if low-fat foods are more readily available, or priced competitively with high-fat and unhealthy foods, even babies born to overweight mothers could counter their prenatal environment and avoid being overweight themselves.

Prater said that this study is central to the philosophies of osteopathic medicine, which promote wellness and preventive care in medicine.

“This helps to show that if you make good choices, you can overcome some of your natural tendencies and be healthier in the long-run,” she said.

 

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Chart: How childhood obesity has swept the world in less than a generation

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A new comprehensive study published in The Lancet looks at the state of obesity around the world, and shares several grim observations, including that no country has managed to curb its obesity epidemic. It also looks specifically at the prevalence of child and adolescent obesity, which has risen significantly around the globe in a matter of “less than one generation.” That troubling ascent can be seen in the chart above, which shows the rising percentage of children who are overweight or obese in 9 distinct countries around the world.

The United States, as is often the case when addressing obesity, is the country that stands out. There is good news in America: Children in the United States, after all, are less likely to be overweight today than they were in the mid 2000s. But there is also bad news: American kids are still far more likely to be overweight than kids in most other countries. Much of that damage has been done over the past thirty years, during which the average weight of an American child has risen by more than 11 pounds, according to the researchers.

 

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Medication, lifestyle changes slow diabetes progression in at-risk population

Women with a history of gestational diabetes face a heightened risk of developing Type 2 diabetes for years after giving birth, but intensive lifestyle intervention or a medication regimen can have a protective effect in this population, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Gestational diabetes is a form of diabetes that occurs during pregnancy, typically in the second trimester. The condition causes glucose levels in the bloodstream to rise above normal levels. Gestational diabetes occurs during as many as 9.2 percent of pregnant women, according to the U.S. Centers for Disease Control and Prevention.

“Our long-term follow-up study found the elevated risk of developing Type 2 diabetes persisted for years in women who had been diagnosed with gestational diabetes, and this long-term risk can best-weight-loss-slimming-clinic-medicine-treatment-islamabad-lahore-karachibe reduced with either intensive lifestyle intervention or the medication metformin,” said one of the study’s authors, Vanita Aroda, MD, of the MedStar Health Research Institute in Hyattsville, MD.

The Diabetes Prevention Program Outcomes Study (DPPOS) analyzed long-term metabolic health in 288 women who had a previous diagnosis of gestational diabetes and 1,226 mothers who did not have a history of the condition. The women all participated in the initial Diabetes Prevention Program study, a randomized clinical trial where they were assigned to intensive lifestyle intervention, the diabetes medication metformin or a placebo. The intensive lifestyle intervention was aimed at reducing body weight by 7 percent and participating in moderate cardio exercise for 150 minutes a week.

During the DPPOS, the women continued to have their blood glucose levels measured twice a year for six years. The study looked at long-term health outcomes in Diabetes Prevention Program participants for about a decade after the women first enrolled in the study.

Women with a history of gestational diabetes who were assigned to take the medication metformin or undergo the intensive lifestyle intervention were less likely to develop Type 2 diabetes than women who received the placebo. When they were assigned the placebo, women who had a history of gestational diabetes had a 48 percent higher risk of developing diabetes compared to women who were never diagnosed with the condition.

Women who had been diagnosed with gestational diabetes and underwent intensive lifestyle intervention had a 35.2 percent reduction in their risk of developing Type 2 diabetes. The risk was reduced by 40.4 percent among women with a history of the condition who were assigned to take metformin.

“Medical and lifestyle interventions were remarkably effective at slowing the progression of Type 2 diabetes in this at-risk population in both the short and long term,” Aroda said.

 

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Injection that makes muscles less energy efficient may have potential as weight-loss therapy to treat obesity

Reducing energy efficiency boosts calorie burning in muscle

Injection that makes muscles less energy efficient may have potential as weight-loss therapy to treat obesity.

What started as an evolutionary protection against starvation has become a biological “bad joke” for people who need to lose weight. The human body doesn’t distinguish between dieting and possible starvation, so when there is a decrease in calories consumed, human metabolism increases its energy efficiency and weight loss is resisted.

In a new study published in the journal Molecular Therapy, a team from the University of Iowa and the Iowa City VA Medical Center has developed a targeted approach to override this “energy best-weight-loss-medicine-in-islamabad-vitatious-saving” mode and allow muscle to burn more energy, even during low to moderate exercise. The new findings might provide the basis of a therapy that could help people get a head start on losing weight by helping to overcome the body’s natural resistance to weight loss.

“Our bodies are geared to be energetically efficient and this often works against us when we are trying to control or reduce our weight,” says study co-author Denice Hodgson-Zingman, MD, UI associate professor of internal medicine. “This study shows for the first time that this energy efficiency can be manipulated in a clinically translatable way. While such an approach would not replace the need for a healthy diet or exercise, it could jump start the process of weight loss by overcoming the initial hurdles imposed by our energy-efficient physiology.”

The new study builds on previous research, which found that a protein called ATP-sensitive potassium (KATP) channel is a powerful modulator of energy efficiency in skeletal muscle even during low-intensity activity. The UI team showed that altering the activity of the KATP protein causes skeletal muscles to become less efficient and burn more calories.

To turn this finding into a therapy, however, the team needed an approach that disrupted the channel’s activity in a very isolated and controlled way. The gene therapy method used in the earlier mouse studies is not feasible for human patients, and a drug that inhibits the channel protein would target not only the channels in muscle but also those in the heart, which could produce very dangerous side effects.

In the new study, the researchers devised a relatively simple solution. They made a compound called a vivo-morpholino, which suppresses production of KATP. Injecting this compound into the thigh muscles of mice produced a local loss of the protein but did not affect the protein in other organs or even in neighboring skeletal muscles. The study showed that the injected muscles burned more calories than untreated muscle without significantly affecting the muscle’s ability to tolerate exercise.

Obesity is a significant public health problem in the developed world, and the CDC estimates that more than one in three American adults are obese. Exercise is considered a mainstay of weight control or weight loss, but many people find it difficult to engage in moderate or strenuous exercise because of other health problems or limitations such as lung or heart disease, arthritis, neuropathy, or stroke.

“By making skeletal muscles less energy efficient, they burn more calories, even while doing [normal] daily activities,” says study co-author Leonid Zingman, MD, UI associate professor of internal medicine and a staff physician at the Iowa City VA Medical Center. “With this intervention, the benefits of exercise in burning calories could be accessible to a broader range of people by making the calorie burning effects of skeletal muscle greater even at low levels of activity that most people would be able to undertake.”

 

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Exercising after a meal can more effectively reduce risks of cardiovascular disease

Exercising after a meal can more effectively reduce risks of cardiovascular disease

Individuals with Type 2 diabetes have heightened amounts of sugars and fats in their blood, which increases their risks for cardiovascular diseases such as strokes and heart attacks. Exercise is a popular prescription for individuals suffering from the symptoms of Type 2 diabetes, but little research has explored whether these individuals receive more benefits from working out before or after dinner. Now, researchers at the University of Missouri have found that individuals with Type 2 diabetes can lower their risks of cardiovascular diseases more effectively by exercising after a meal.best-weight-loss-slimming-clinic-in-islamabad-lahore-karachi-vitatious

“This study shows that it is not just the intensity or duration of exercising that is important but also the timing of when it occurs,” said Jill Kanaley, professor in the MU Department of Nutrition and Exercise Physiology. “Results from this study show that resistance exercise has its most powerful effect on reducing glucose and fat levels in one’s blood when performed after dinner.”

Kanaley and her colleagues studied a group of obese individuals with Type 2 diabetes. On one occasion, participants performed resistance exercises before eating dinner. During another visit, participants exercised 45 minutes after eating dinner. Participants performed resistance exercises such as leg curls, seated calf raises and abdominal crunches. Compared to levels on a non-exercise day, Kanaley found that the participants who exercised before dinner were able to only reduce the sugar levels in their blood; however, participants who exercised after dinner were able to reduce both sugar and fat levels. Participants consumed a moderate carbohydrate dinner on the evenings of the study.

Kanaley said her research is particularly helpful for health care providers who have patients who exercise every day but are not seeing benefits.

“Knowing that the best time to exercise is after a meal could provide health care professionals with a better understanding of how to personalize exercise prescriptions to optimize health benefits,” Kanaley said.

Kanaley also found that improvements in participants’ blood sugar and fat levels were short-lived and did not extend to the next day. She suggests individuals practice daily resistance exercise after dinner to maintain improvements.

“Individuals who exercise in the morning have usually fasted for 10 hours beforehand,” Kanaley said. “Also, it is natural for individuals’ hormone levels to be different at different times of day, which is another factor to consider when determining the best time to exercise.”

In the future, Kanaley said she plans to research how exercising in the morning differs from exercising after dinner and how individuals’ hormone levels also affect exercise results.

The study, “Post-dinner resistance exercise improves postprandial risk factors more effectively than pre-dinner resistance exercise in patients with type 2 diabetes,” was published in the Journal of Applied Physiology.

 

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The Atkins Diet is also known as the Atkins Nutritional Approach. It was created by Dr. Robert Atkins, an American cardiologist.

Dr. Atkins read about a diet in JAMA (Journal of the American Medical Association) and devised one in order to reduce his own weight. He then used his devised diet to help his patients.

About Dr. Atkins

Dr. Atkins graduated from the University of Michigan in 1951 and received his medical degree from Weill Cornell Medical College in 1955 – he went on to specialize in cardiology and OLYMPUS DIGITAL CAMERAcomplementary medicine.

Robert Atkins wrote a series of books; Dr. Atkins’ Diet Revolutionwas his first book and was written in 1972. Later books revised his original specifications – however, he never moved far from the original concepts of low carbohydrates (carbs) and insulin control.

On 8th April, 2003, Dr. Atkins slipped on ice while on his way to work – he fell and hit his head on the ground, causing bleeding around his brain. He became unconscious on the way to hospital and died in hospital after two weeks in an ICU (intensive care unit).

What is the Atkins Diet?

The thrust of the Atkins Nutritional Approach is to significantly reduce one’s carbohydrate (carbs) intake. The craze for low carbs comes mainly from the popularity of the Atkins’ books. The Atkins diet is a four-phase eating program, combined with vitamin and mineral supplements, as well as regular exercise.

Dr. Atkins said there are crucial unrecognized factors in our eating habits which make us fat. The main factor that causes us to put on weight is our consumption of refined carbs, especially sugar, high-fructose corn syrup, and flour.

When on the Atkins Diet, the dieter’s body’s metabolism switches from burning glucose as fuel to burning its own stored body fat – this switching is called ketosis. When our glucose levels are low our insulin levels are low. Ketosis kicks in when our insulin levels are low. In other words, when our glucose levels are low our bodies switch to using our own stores of fat as a source of energy.

Our insulin levels, because of our low glucose levels, are low just before we eat. As soon as we eat our glucose levels rise, which triggers our insulin levels to rise. Refined carbohydrates are full of glucose which enters our blood rapidly.

Other types of carbs, what we call “good carbs” do not have such a strong impact on blood glucose levels, compared to refined carbs. During ketosis, some of the fat (lipid) stores in fat cells are transferred to the blood (lipolysis).

According to Dr. Atkins’ New Diet Revolution1, a diet which is low in carbs triggers a metabolic advantage – the body burns more calories than it would on other diets. During this metabolic advantage the body also gets rid of some unused calories.

Dr. Atkins talked a lot about Net Carbs. Net carbs are the total carbs minus fiber and sugar alcohols. Sugar alcohols have a minimal effect on blood sugar levels. The best carbs, said Dr. Atkins, are those with a low glycemic load. Dr. Atkins also said that a person´s saturated fat intake should be kept to a maximum of 20% of all his consumed calories.

Atkins said that for patients with Diabetes Type 2 or metabolic syndrome, the Atkins diet lowers, and sometimes even eliminates the need for medications. However, professional diabetitians warn that although watching carbs and glucose intake are a vital part of diabetes care, the Atkins Diet is not a simple solution for diabetes.

What are the four phases to the Atkins Diet?

Phase 1: Induction

Calorie consumption from carbs limited to 20 grams each day. Carb sources are mainly from salad and vegetables which are low in starch.

Phase 2: OWL (Ongoing Weight Loss)

Nutrient-dense and fiber rich foods are added as additional carb sources, at an increased rate of 25 grams during the first week of this phase, 30 grams during the second week, and 30 grams each subsequent week until your weight stops going down. At that point – when weight loss stops – take away 5 grams of carbs from your daily intake until you are starting to lose weight slowly.

Phase 3: Pre-Maintenance

Increase your carb intake by 10 grams each week until your weight loss is very gradual.

Phase 4: Lifetime Maintenance

Start adding a wider range of carb sources, while carefully monitoring your weight does not go up. Your sense of well-being must continue. If your weight starts to go up, ease back on two things – the amount of carbs you consume each day, and any of the new carbs you have been introducing. Dr. Atkins says that “this lifestyle is the foundation for a lifetime of better health”.

The four principles of the Atkins Diet

According to Dr. Atkins, the Atkins Diet has four principles which form the core of the Atkins Nutritional Approach. They are:

  • You Will Lose Weight
  • You Will Maintain Your Weight Loss
  • You Will Achieve Good Health
  • You Will Lay The Permanent Groundwork For Disease Prevention

How effective is the Atkins Diet?

If you stick to it, it is effective. You will lose weight and keep it off. The problem is sticking to it – compliance. During the early part of this decade approximately 10% of adults in the USA were on some kind of Atkins low carb diet. However,obesity and overweight continued to rise rampantly during this time.

The low-carb craze made virtually no dent at all in the fight against obesity – not nationally, anyway. The problem was not that low carbs or good carbs do not work – they do. The problem was, and still is, that people drop out of the diet, as they do with most other diets.

Study after study found that after two or three years, the vast majority of people who started well on Atkins did not continue long-term. In the medium-term the Atkins Diet tends to fare better than most other diets.

Researchers at Stanford University carried out a study and found that people following the Atkins diet had best blood pressure levels, better cholesterol levels and lost the most weight, compared to people on other diets.


According to experts, Global obesity response is ‘unacceptably slow’

 

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According to experts, Global obesity response is ‘unacceptably slow’

A new six-part series published in The Lancet claims that progress is “unacceptably slow” in tackling the ongoing obesity epidemic and demands new ways of thinking.

According to the articles, only 1 in 4 countries have been implementing a policy on healthy eating up to 2010.

The Lancet series notes that although rates of child obesity have started to level off in certain cities and countries, no country to date has seen declining rates of obesity on a population-wide level.

Children in the US, for example, weigh an average of 5 kg more than they did 30 years ago, with 1 in 3 children being overweight or obese.

In new estimates produced for the series, The Lancetreports that American children are consuming an average of 200 kcal more per day than they were in the 1970s. This extra consumption works out as an extra $400-worth of food being consumed per child per year, adding up to an extra $20 billion in annual sales for the US food industry.

Put simply? “Fat children are an investment in future sales.” This is the opinion of Dr. Tim Lobstein from the World Obesity Federation, co-author of the series, who also calls for an integrated approach in tackling both over nutrition and under nutrition.

“Undernutrition and overnutrition have many common drivers and solutions, so we need to see an integrated nutrition policy that tackles both these issues together to promote healthy growth for children,” says Dr. Lobstein.

More than a fifth of children under 5 years of age are affected by stunting in low- and middle-income countries, but rapidly rising levels of obesity in these same countries can also pose a threat to these populations. As an example of how these combined problems might affect individuals, the authors explain that poorly nourished infants may not develop their full height but still gain more than their full weight.

As such, the report emphasizes the importance of ensuring that the supply of food encouraging healthy growth is not jeopardized by the food industry’s aggressive marketing of cheap, less nutritious products.

The food industry, the authors remind, has a special industry in targeting children. Taste preferences and brand loyalty are established during infancy, so the industry pushes highly processed foods and sweetened drinks on children from a young age.

Illustrating this point, the authors report that the global market for processed infant foods is expected to be worth $19 billion in 2015, up from $13.7 billion in 2007.

Governments rely on food industry’s voluntary initiatives, rather than proposing solutions

Countries are not taking necessary steps to protect children from obesity, the report finds, with both regulation and healthy food policies lacking. Instead, most countries rely on the food industry’s own voluntary initiatives, and there is no evidence for these programs’ effectiveness.

“It’s time to realize that this vicious cycle of supply and demand for unhealthy foods can be broken with ‘smart food policies’ by governments alongside joint efforts from industry and civil society to create healthier food systems,” says Dr. Christina Roberto, from the Harvard T.H. Chan School of Public Health in Boston, MA.

Among the recommendations set out in the series are a call for civic action to combat obesity – similar to the pressure from the public that saw universal health care access granted to HIV/AIDS patients in South Africa – and that more must be done to improve the training of health care professionals.

Part of this training should be to counter biases about patients with obesity and improve delivery strategies for care, say the authors.

Series lead author, Prof. Boyd Swinburn from the University of Auckland, New Zealand, summarizes the recommendations:

“The key to meeting WHO’s target to achieve no further increase in obesity rates by 2025 will be strengthening accountability systems to support government leadership, constraining the role of the food industry in the formation of public policy, and encouraging civil society to create a demand for healthy food environments.”

 

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Low-fat, plant-based vegan diet ‘may reduce heart disease risk’ in obese children

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Among the complications of obesity include an increased risk of heart disease. But for children and adolescents who are obese, this risk could be reduced with a low-fat, plant-based vegan diet. This is according to a new study published in The Journal of Pediatrics.

Childhood obesity is a major problem in the US. Over the last 3 decades, the rate of obesity has more than doubled in children aged 6-11 years and quadrupled in adolescents aged 12-19.

As well as raising the risk of obesity later in life, children and adolescents who are obese have greater risk of stroke, type 2 diabetes and heart disease. According to the Centers for Disease Control and Prevention (CDC), a population-based study found 70% of obese 5-17-year-olds have at least one risk factor for cardiovascular disease.

In order to help reduce such risks, the American Heart Association (AHA) recommend eating a diet consisting of fruits, vegetables, low-fat dairy products, fish, poultry and nuts, while red meat and sugary foods and drinks should be consumed in moderation.

But the researchers of this latest study, led by Dr. Michael Macknin, a staff pediatrician at Cleveland Clinic Children’s, OH, suggest a plant-based diet low in fat may be more effective for lowering the risk of heart disease in children and adolescents.

Participants randomized to either plant-based or AHA diets

To reach their findings, Dr. Macknin and his team enrolled 28 obese children and adolescents aged 9-18 years to the study. All participants had high cholesterol levels – a risk factor for heart disease.

The subjects were randomized to follow either the AHA diet or a plant-based diet for 4 weeks, and one parent of each child also followed the diet plan their child was assigned to.

The participants who followed the plant-based diet ate plants and whole grains, but consumed no added fat and no animal products. Consumption of avocado and nuts was limited. This reduced their intake of animal protein from 42 g a day to 2.24 g a day, while their percentage of calories from fat and saturated fat fell to 18% and 3.6%, respectively.

Those who followed the AHA diet consumed less than 30% of their total daily calories from fat and less than 7% of their total daily calories from saturated fat. They also consumed less than 1,500 mg of sodium and less than 300 mg of cholesterol each day.

In addition to their diets, the participants attended weekly 2-hour nutrition education sessions.

Plant-based diet more effective for reducing heart disease

At the end of the 4-week diet plans, the researchers found the children and adolescents who followed the plant-based diet showed major improvements in body mass index (BMI), weight, mid-arm circumference, systolic blood pressure, total cholesterol, low-density lipoprotein (LDL), or “bad” cholesterol, and insulin.

They also showed improvements in myeloperoxidase and high-sensitivity C-reactive protein – which the researchers say are two common indicators of heart disease.

While still beneficial, those who followed the AHA diet only showed improvements in weight, waist circumference, mid-arm circumference and myeloperoxidase, indicating that the plant-based diet was more effective.

Commenting on the team’s findings, Dr. Macknin says:

“As the number of obese children with high cholesterol continues to grow, we need to have effective lifestyle modifications to help them reverse their risk factors for heart disease.

We’ve known that plant-based diets are beneficial in adults in preventing and possibly reversing heart disease. This study shows that the same may be true in children too, though more studies are needed.”

Dr. Macknin notes that the study participants only followed the plant-based diet for 4 weeks, but significant health benefits were seen in that short period. “[…] Imagine the potential for improving long-term health into adulthood if a whole population of children began to eat these diets regularly,” he adds.

Though the majority of the children, adolescents and their parents were able to follow the plant-based diet for the 4-week study period, Dr. Macknin notes that they found purchasing the required food challenging; it was difficult to find and highly priced. This could pose problems for families wanting to follow the diet for longer periods.

“So we know that plant-based diets are effective, but if they are to be widely used, we need to make access to plant-based, no-added-fat foods easier and more affordable,” says Dr. Macknin.

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Healthy diet, exercise ‘not enough to treat obesity,’ say experts

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People who are obese are often told to eat healthier and exercise more in order to lose weight. But in an article recently published in The Lancet Diabetes & Endocrinology, obesity experts claim the condition is a chronic disease that can be caused by biological factors, meaning many cases may not be cured with a healthy diet and physical activity alone.

In the US, around 35% of adults and 17% of children and adolescents are obese. Both the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) cite a healthy diet and exercise as a primary factor in combating obesity. But is it really that simple?

Not according to lead author Dr. Christopher Ochner, assistant professor of pediatrics and psychiatry at the Icahn School of Medicine at Mount Sinai in New York, NY, and colleagues.

In their article, the experts state that while a healthy diet and exercise may help obese individuals lose weight in the short term, around 80-95% eventually gain back that weight.

They explain that this is partly because a reduced intake of calories can activate a type of biological “fat-loss defense” that encourages the body to stay at a higher weight.

According to the authors, this defense mechanism once protected humans when food was scarce. In these modern times, however, humans tend to have higher body weights for longer periods. As such, the defense mechanism drives calorie consumption and fat storage so a higher body weight can be maintained.

Most obese people ‘unable to override fat-loss defense’ with diet and exercise

The authors say that in a 21st century environment where high-calorie, high-fat foods are the norm, alongside low levels of physical activity, the majority of people who are obese are unable to override the defense mechanism simply through lifestyle changes.

Dr. Ochner adds:

“Although lifestyle modifications may result in lasting weight loss in individuals who are overweight, in those with chronic obesity, body weight seems to become biologically ‘stamped in’ and defended.

Therefore, the current advice to eat less and exercise more may be no more effective for most individuals with obesity than a recommendation to avoid sharp objects for someone bleeding profusely.”

What is more, Dr. Ochner says that even individuals who were obese and have achieved significant weight loss through dieting may not be able to escape the fat-loss defense mechanism.

“Few individuals ever truly recover from obesity; rather they suffer from ‘obesity in remission,'” he adds. “They are biologically very different from individuals of the same age, sex, and body weight who never had obesity.”

If this is the case, what can obese individuals do to sustain long-term weight loss?

Obesity should be recognized as a ‘chronic and often treatment-resistant disease’

The authors believe the biological mechanisms preventing long-term weight loss need to be addressed going forward.

They note that one form of gastric bypass surgery – known as Roux-en-Y – has been shown to be effective in reversing changes in appetite-related hormones caused by obesity, which affects how the brain responds to food. They say this may be why bariatric surgery appears to be the only obesity treatment that works long term.

In order to tackle obesity, Dr. Ochner says the condition needs to be recognized as a “chronic and often treatment-resistant disease with both biological and behavioral causes,” and it should be treated with biological interventions as well as lifestyle changes.

“Ignoring these biological factors and continuing to rely on behavioral modification will surely result in the continued inability to treat obesity effectively and the premature death of millions of individuals each year,” he adds.

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